1. ACNM, ACOG, SMFM Clarify Content of Recent Consensus Statement on Levels of Maternal Care2. ACNM Web Page on Maternity Shortage Area Legislation Now Available3. Two Pieces of Federal Legislation Expand APRN Roles in Medicare and the VA4. National Health Service Corps Releases 2015 Application and Program Guidance for Scholarship Program5. Students -- You Can Get Involved in ACNM's Government Affairs Committee and Midwives-PAC

A brief perusal of this and many of our past ACNM Policy Updates makes it obvious that there is a LOT going on legislatively, particularly in the states. Many of you are deeply involved in an impressive array of work. Cara Kinzelman, ACNM's Manager of State Government Affairs is also doing a tremendous job supporting our affiliates in their advocacy work.

To support our efforts, we need as many midwives as possible to participate. The simplest way is by responding to the ACNM Action Alerts that we send out.

Numbers matter and right now, there are thousands of CNMs/CMs out there who are not ACNM members and thus, are not receiving these Updates or our Action Alerts.

If you know any of these folks, tell them how important their contribution is, how much we need them, what ACNM is doing to support midwives and encourage them to join so that they can be part of this team effort.

A new study by Duke University researcher Christopher J. Conover, titled “Economic Benefits of Less Restrictive Regulation of Advanced Practice Registered Nurses in North Carolina,” looks specifically at North Carolina’s regulations and compares them with the overwhelmingly positive outcomes in states that have already updated the ways that APRNs are regulated. “Modernizing APRN regulations has the potential to positively impact health care access, quality, and cost,” Conover said. “It is rare that any policy change offers gains across all three major dimensions of the North Carolina health system’s performance.”

It is anticipated that this study will make a positive contribution to the efforts of North Carolina APRNs to achieve full practice authority. Importantly, the study directly refutes one of the key opposition talking points that attempts to warn of patient safety implications with the enactment of full practice. By looking at outcome studies in states that have already modernized APRN regulation, Conover found that, “While these studies vary greatly in methodological rigor, each has concluded that APRN practice outcomes are equivalent or better than those of physicians.”

Michigan S.68, a full practice authority bill, was heard in the Health Policy Committee this week. A highlight of the hearing was supportive testimony given by an obstetrician with over 30 years’ experience working with CNMs and other advanced practice nurses. He stated, in part, that:“Throughout my career, I have found Advanced Practice Registered Nurses to be responsible, thoughtful providers of care that consistently meet the highest standards. Quality, effective health care requires a team effort…In my experience, APRNs, by virtue of their nursing education and philosophy of care, consistently promote a team model and can be expected to continue to do so. The most important point is that we will reach our shared goals of quality and cost efficiency only when all team members all allowed to practice to their fullest capacity based on educational preparation and experience.”

The Michigan ACNM affiliate also offered supportive testimony. The bill has two more hearings in the same committee in upcoming weeks. The next hearing is scheduled for March 10.

Current Colorado law requires an APRN to complete 1,800 hours of prescribing in a preceptorship to obtain provisional prescriptive authority and to complete 1,800 hours of prescribing in a mentorship in order to achieve full prescriptive authority. Colorado S.197 would reduce the requirement to achieve full prescriptive authority to 1,000 practice hours and allow provisional prescriptive authority upon graduation and passage of the certification examination, among other things.

Colorado is seeking this change because it has become clear that existing requirements are too onerous and are resulting in APRNs seeking employment elsewhere, as recently reported by the Colorado Center for Nursing Excellence. The Colorado experience is an important model to study, as transition to practice requirements similar to what is currently required in Colorado have become a favored compromise in states seeking full practice authority.

5. Nebraska Approves Full Practice Authority Measure for NPs

The Nebraska legislature voted 46-0 in support of a full practice authority bill limited to nurse practitioners and this week the Governor signed the bill into law. The bill eliminates integrated practice agreements and replaces them with a 2,000 hour transition to practice agreement. A similar bill last session was vetoed by the Governor. Advocates for the bill report that last year’s veto actually ended up working in their favor due to the amount of media coverage (and associated backlash) it generated.

Colorado H.1111 creates the Colorado Maternal Mortality Review Committee for the purpose of reviewing maternal mortality cases that occur in Colorado, identifying the causes of maternal mortality, and developing recommendations to prevent further maternal mortalities. The bill has passed the House.

Indiana H.1548 proposes to remove the requirement that direct-entry midwife (non-CNMs) have a collaborative agreement with a physician, among other things. The bill has passed the House.

Kentucky H.218 proposes to require employers to make reasonable accommodations for pregnancy, childbirth, and related medical conditions, with some exclusions. The bill has passed the House.

Kentucky S.74 proposes to mandate priority access for pregnant women to substance abuse treatment or recovery service programs and provide practitioners civil immunity for failing to recognize controlled substance abuse by a pregnant patient or referring a pregnant patient to substance abuse treatment or recovery services consistent with community standards of care, among other things. The bill has passed the Senate.

Maine LD.521 would lessen some of the requirements of Maine’s truth in advertising statute by eliminating the requirement for providers in face-to-face contact with patients to display a copy of their license.

Maryland S.74 proposes to create the Task Force to Study Maternal Mental Health, which would identify vulnerable populations and risk factors in the state for maternal mental health disorders that may occur during pregnancy and through the first postpartum year and identify successful postpartum mental health initiatives in other states and recommend programs, tools, strategies, and funding sources that are needed to implement similar initiatives in the Maryland, among other things. The bill has passed the Senate.

Missouri H.112 would allow the Board of Nursing and others to individually or collectively enter into a contractual agreement with the Department of Health and Senior Services, a public institution of higher education, or a nonprofit entity for the purpose of collecting and analyzing workforce data from its licensees, registrants, or permit holders for future workforce planning and to assess the accessibility and availability of qualified health care services and practitioners in Missouri. The bill passed the House.

Ohio S.90 is a truth in advertising bill that would require providers to wear identification card when providing patient care with the provider’s full name, a recent photo, date licensure expires, and the name of the professional or facility that employs the provider, with some exceptions.

South Dakota S.60 proposes to require newborn screening for inherited and genetic disorders in addition to the current requirement to screen for metabolic disorders. The bill has passed both chambers.

Texas H.1885/S.751 deletes the requirement for a collaborative agreement with a physician for prescriptive authority, among other things.

West Virginia H.2829 defines the practice of direct-entry midwifery and requires DEMs to participate in annual reporting to the Division of Vital Statistics. The bill does not create a licensure mechanism. It has passed the House.

After ACOG and SMFM released their consensus statement of Levels of Maternal Care, ACNM members identified language in the document that could, if misinterpreted, result in restrictions on midwifery practice. To ensure that the document is correctly interpreted by all stakeholders, ACNM prepared a letter to ACOG and SMFM outlining the concern that had been raised and suggesting a resolution.

ACOG and SMFM responded to ACNM's letter, acknowledging the importance of the issue raised by ACNM and validating the interpretation offered by ACNM as the correct way to understand the document. Both of these letters have been posted to ACNM's website.

2. ACNM Web Page on Maternity Shortage Area Legislation Now Available

ACNM has created a brief web page with details about S. 628/H.R. 1209, the "Improving Access to Maternity Care Act of 2015." The page includes links to the text of the legislation and list of cosponsors, an issue brief, talking points and links to press releases from pertinent stakeholders.

If you haven't yet contacted your legislators to express support for this important bill, do so today by visiting ACNM's Action Center!

3. Two Pieces of Federal Legislation Expand APRN Roles in Medicare and the VA

Two pieces of recently introduced federal legislation make changes to federal health programs that result in expansion of the roles of APRNs within those programs. ACNM has actively supported these bills, in coalition with the APRN Workgroup and the Nursing Community.

The "Home Health Planning and Improvement Act of 2015" (S. 578/H.R. 1342) would allow nurse practitioners, certified nurse-midwives, and clinical nurse specialists to certify the need of home health services under the Medicare program. Currently only physicians are allowed to provide such certifications.

The “Improving Veterans Access to Quality Care Act of 2015” (H.R. 1247) would require the Veterans Health Administration to provide full practice authority to certified registered nurse anesthetists, nurse practitioners, clinical nurse specialists and certified nurse-midwives. While the VA is currently in the process of modifying its Nursing Handbook to provide such authority through guidance, we are advocating on behalf of this bill, as it would enshrine such a provision in law. The legislation would bring the VHA into line with the current practices of the Department of Defense, Bureau of Indian Affairs and Public Health Services which all allow full practice authority to these APRNs.

4. National Health Service Corps Releases 2015 Application and Program Guidance for Scholarship Program

The National Health Service Corps has released the 2015 Application and Program Guidancefor the NHSC Scholarship Program. The application cycle will close on May 7, 2015, at 7:30 p.m. ET.

-- The NHSC Scholarship Program awards scholarships to health professions students willing to work as a primary care provider in specified health professionals shortage areas.-- Scholarship support includes tax-free payment of tuition, required fees, other reasonable educational costs, and a taxable monthly living stipend.-- All students applying to the program must be a U.S. citizen or national and enrolled or accepted in an eligible degree program at a U.S. accredited school. Among the list of acceptable degree programs are those for certified nurse-midwives.

NHSC Scholarship Program recipients fulfill their service commitment at an NHSC-approved site upon completion of their graduation and/or training. For each year of financial support (up to four years) a Scholarship recipient serves one year at an NHSC-approved site in a high-need urban, rural, or frontier community. All recipients must serve a minimum of two years.

The NHSC Scholarship Program is competitive. Applicants are encouraged to submit their application early. Technical assistance activities have been scheduled to address questions. You should visit the NHSC website to learn more.

5. Students -- You Can Get Involved in ACNM's Government Affairs Committee and the Midwives-PAC

If you are a CM or CNM student interested in the Government Affairs Committee (GAC) and/or Midwives-Political Action Committee (Midwives-PAC), you can become a School Legislative Contact (SLC) to help with the work of these two important committees in your own school. Check here to see current SLCs. ACNM membership is not required (though recommended) for working as an SLC. Each school can have more than one SLC, so sign up if you want to be part of the fun!

In addition, the Government Affairs Committee (GAC) and Midwives-Political Action Committee (Midwives-PAC) seek four Student Representatives to sit on these committees for a minimum one-year term starting at the 2015 ACNM Annual Meeting. Applicants do not need prior legislative or policy experience. Attendance at the 2015 Annual Meeting is strongly preferred, as Lobby Day in DC and the annual Midwives-PAC Rally are essential committee activities. This position is a great way to learn about the legislative process, work collaboratively with other midwives and student midwives to advance midwifery, and have fun along the way. Please send an email of interest and resume to[email protected] by May 1, 2015. ACNM membership is required to be a member of the GAC or PAC committees. Click here to see a job description.

Should you have questions about state issues, please contact Cara Kinzelman, ACNM's Manager of State Government Affairs at [email protected] or 240-485-1841.

If you have questions regarding federal issues, please contact Jesse Bushman, ACNM’s Director of Advocacy and Government Affairs at [email protected] or 240-485-1843.

Not an ACNM member? You can access all of the member benefits, including receipt of every ACNM Policy Update, by joining today.